News Briefs

September 5, 2019

✦ The North Carolina Dept. of Health and Human Services (DHHS) on Sept. 3 said it would not begin phasing in the implementation of its new managed Medicaid program on Nov. 1 and instead deploy a statewide transition from fee-for-service to managed care on Feb. 1, 2020. The transition was initially scheduled to roll out in two phases, but was adjusted “because DHHS cannot implement critical actions to go-live with managed care under the current continuing resolution budget,” the agency explained. DHHS said it has extended open enrollment for beneficiaries in the 27 counties that were scheduled to transition in November. Four managed care organizations will serve the new program statewide; Centene Corp. has a regional contract (RMA 2/7/19, p. 5). Visit https://bit.ly/2lYQNNd.

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✦ The North Carolina Dept. of Health and Human Services (DHHS) on Sept. 3 said it would not begin phasing in the implementation of its new managed Medicaid program on Nov. 1 and instead deploy a statewide transition from fee-for-service to managed care on Feb. 1, 2020. The transition was initially scheduled to roll out in two phases, but was adjusted “because DHHS cannot implement critical actions to go-live with managed care under the current continuing resolution budget,” the agency explained. DHHS said it has extended open enrollment for beneficiaries in the 27 counties that were scheduled to transition in November. Four managed care organizations will serve the new program statewide; Centene Corp. has a regional contract (RMA 2/7/19, p. 5). Visit https://bit.ly/2lYQNNd.

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CMS Opens Additional Doors With 2020 Marketing Updates

August 15, 2019

In keeping with the administration’s theme of lessening the burden for Medicare Advantage and Medicare Part D organizations, CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

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In keeping with the administration’s theme of lessening the burden for Medicare Advantage and Medicare Part D organizations, CMS’s newly updated Medicare Communications and Marketing Guidelines (MCMG) contain multiple flexibilities that were previously unavailable to plan sponsors. These include a loosening of rules around co-branding, educational events and marketing of rewards and incentives programs (RI programs), as well as the ability to operate a call center dedicated to prospective enrollees.

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Rewards Vendors Vie for MA Business as CMS Relaxes Rules

August 15, 2019

Since a 2015 CMS rule gave Medicare Advantage plans more flexibility to offer rewards and incentives programs (RI programs), the agency has continued to loosen up what was historically a limited benefit, allowing completed health risk assessments to qualify as rewardable activities starting in 2019 (RMA 3/1/18, p. 1) and now offering some flexibility around plan marketing of specific rewards and incentives (see story, p. 1). This is potentially good news for the many RI program vendors that have sprung up in recent years as health plans become more interested in incentivizing healthy behaviors that can lead to higher star ratings and HEDIS scores. AIS Health spoke with three vendors to learn more about this increasingly competitive space and how they are attempting to differentiate themselves.

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Since a 2015 CMS rule gave Medicare Advantage plans more flexibility to offer rewards and incentives programs (RI programs), the agency has continued to loosen up what was historically a limited benefit, allowing completed health risk assessments to qualify as rewardable activities starting in 2019 (RMA 3/1/18, p. 1) and now offering some flexibility around plan marketing of specific rewards and incentives (see story, p. 1). This is potentially good news for the many RI program vendors that have sprung up in recent years as health plans become more interested in incentivizing healthy behaviors that can lead to higher star ratings and HEDIS scores. AIS Health spoke with three vendors to learn more about this increasingly competitive space and how they are attempting to differentiate themselves.

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Aetna, Humana Project Major MA Enrollment Gains in 2019

August 15, 2019

Following a 16% year-to-date increase in Medicare Advantage membership reported by Anthem, Inc. last month (RMA 8/1/19, p. 1), Aetna Inc. and Humana Inc. in recent weeks posted second-quarter 2019 earnings that were aided by substantial growth in their MA segments, while Cigna Corp. expressed confidence in its ability to grow that business in 2020.

CVS Health Corp. on Aug. 7 reported a 55% year-over-year increase in consolidated adjusted operating income to $4 billion, which it mainly attributed to the November 2018 addition of Aetna Inc. and growth of the pharmacy benefit manager. The Health Care Benefits segment, which includes MA and the SilverScript Part D business, contributed $17.4 billion of revenue, which on a consolidated basis grew 35.2% to $63.4 billion as of June 30, 2019.

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Following a 16% year-to-date increase in Medicare Advantage membership reported by Anthem, Inc. last month (RMA 8/1/19, p. 1), Aetna Inc. and Humana Inc. in recent weeks posted second-quarter 2019 earnings that were aided by substantial growth in their MA segments, while Cigna Corp. expressed confidence in its ability to grow that business in 2020.
CVS Health Corp. on Aug. 7 reported a 55% year-over-year increase in consolidated adjusted operating income to $4 billion, which it mainly attributed to the November 2018 addition of Aetna Inc. and growth of the pharmacy benefit manager. The Health Care Benefits segment, which includes MA and the SilverScript Part D business, contributed $17.4 billion of revenue, which on a consolidated basis grew 35.2% to $63.4 billion as of June 30, 2019.

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Working Group Recommends New SSBCI Be Clear, Equitable

August 15, 2019

Beginning in 2020, Medicare Advantage organizations will be able to offer “non-primarily health related” items and services to certain beneficiaries through Special Supplemental Benefits for the Chronically Ill (SSBCI) established in the Bipartisan Budget Act of 2018. CMS has given plan sponsors broad discretion in developing non-medical services that were previously not allowed in MA plan bids and is allowing them to target certain benefits to individuals’ conditions and needs, but a working group of diverse stakeholders suggests that a set of “guiding principles” is needed to ensure the successful implementation of new SSBCI.

While the new benefit category provides MAOs with an “unprecedented degree of flexibility” to address social determinants of health, it “also creates challenges around benefit clarity, equity and manageability,” observes the new report, “A Turning Point in Medicare Policy: Guiding Principles for New Flexibility Under Special Supplemental Benefits for the Chronically Ill.”

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Beginning in 2020, Medicare Advantage organizations will be able to offer “non-primarily health related” items and services to certain beneficiaries through Special Supplemental Benefits for the Chronically Ill (SSBCI) established in the Bipartisan Budget Act of 2018. CMS has given plan sponsors broad discretion in developing non-medical services that were previously not allowed in MA plan bids and is allowing them to target certain benefits to individuals’ conditions and needs, but a working group of diverse stakeholders suggests that a set of “guiding principles” is needed to ensure the successful implementation of new SSBCI.
While the new benefit category provides MAOs with an “unprecedented degree of flexibility” to address social determinants of health, it “also creates challenges around benefit clarity, equity and manageability,” observes the new report, “A Turning Point in Medicare Policy: Guiding Principles for New Flexibility Under Special Supplemental Benefits for the Chronically Ill.”

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